Making Waves

New Strides in Aquatic Safety

By Jessica Royer Ocken

When it comes to aquatic safety, there are more factors to consider than grains of sand on a beach—even if you're not managing a beach. Indoor and outdoor community pools, aquatic centers and lakes boast broad consumer appeal and myriad exercise and entertainment benefits, but keeping these environments safe and healthy requires multifaceted vigilance and organized attention.

Are you exhausted already? We understand. And we're happy to report that after surveying the scene and gathering the latest information about what's new and evolving in the world of water safety, we've discovered a lot out there that can help you create and maintain a safe aquatic landscape. From preventing drowning to training lifeguards, from educating users to keeping your facility healthy, there's an array of options to make your job more manageable. Have a look!

Preventing Drowning

A drowning accident is absolutely the worst-case scenario for any water-based activity center, so it's no wonder that so much interest and innovation are devoted to minimizing these incidents. "Our society and culture seem to continue to move toward less tolerance of hardship to people," said Tom Lachocki, CEO of the National Swimming Pool Foundation (NSPF). "With that in mind, lots of attention [is being directed toward] how to minimize preventable accidents, such as drowning."

In some cases, both pools and "dark water" recreation areas (like the swimming lake at summer camp) are turning to technology for assistance with drowning prevention. Computer-based systems like Wahooo, Poseidon and Safety Turtles add a layer of backup protection for lifeguards by sounding the alert any time there's an anomaly in the water, whether it's a swimmer who doesn't resurface or move for awhile or someone splashing frantically to indicate distress.

Some of the systems use cameras trained on the clear water of an indoor or outdoor pool to spot problems, and others track transmitters worn by those using the water. One transmitter-style system works in dark water like lakes and ponds where a camera can't see much, and transmitter-based systems are also helpful for situations where submersion is not intentional and a person in trouble may not generate a lot of splashing—such as with water aerobics or therapy for seniors. (See "A Life-Saving Solution" in the February 2010 issue of Recreation Management, for an example)

A number of YMCAs around the country have adopted these drowning prevention systems over the past decade. The most recent is the YMCA of Birmingham, Ala., which currently has a monitoring system on four of their 17 pools and plans to install three more systems this year. The YMCA of Metropolitan Atlanta has 24 systems on 24 pools, with plans to add two more (pools and systems). President and CEO Ed Munster said that they learned of the technology about 11 years ago when an engineer in their pool design group brought it to their attention. They immediately made plans to begin implementing the systems.

And that was some undertaking. The systems can be costly, especially when being retrofitted to an existing pool, but Munster was adamant. "There's no way we were going to have a different quality of care in one location than another, so it was either do it all, or not at all," he said. As for the cost, given the YMCA's mission to serve the community and provide a safe, nurturing environment, he felt adding drowning-prevention technology was simply "the right thing to do.

"This is foundational for us," he added. "It's the cost of being in the business we're in. We're a large swimming pool owner. There's lots of risk there, so we want to do all we can to help our staff do their job," he explained, noting that the Y would never use the system as a replacement for human lifeguards or as a means to trim the guarding staff.

He also noted that the alternative to such technology can be rather costly as well. "How cheap is a death?" he asked frankly. "You won't find another Y in the country as bottom-line-oriented as we are, but we also have to take care of the top line: the people. You only have your reputation once. If you can't operate after a drowning or event…you're not serving the community at all. You have to look at the big picture."

When asked about measurable benefits of having this technological assistance in place, Munster said that the YMCA of Metropolitan Atlanta has an excellent lifeguarding staff, so they don't have a lot of incidents. "We've had events where we've had rescues, and they probably would have made them just fine without [the system], but this is for one of those once-in-a-lifetime things that may happen," he said. For example, he asked, what if someone had a heart attack in the pool?

In terms of impact on lifeguards, YMCA of Metropolitan Atlanta Group Vice President Kristin McEwen said that the only additional information guards need to learn are the basics of how the system works. Turning it on in the morning and off at the end of the day then become part of the standard pool operating procedures.

"Lifeguards are never supposed to take their eyes off pool, so when people are coming in and asking the guard questions, trying to find their lessons, those are distraction points," she explained. "[With this system in place] we have the ability to know that if a lifeguard is distracted for a second, something would alert them if something happened. … [When you] come in as lifeguard, at some point it's your first day and you're a wreck because you know everyone there is your responsibility," she continued. But lifeguards at these pools know they have a built-in backup to help them succeed. "As an organization we always look for ways to support our staff so they can be as effective in their role as possible," McEwen said.

She includes details about the system and video demonstrations of how it can work in monthly and yearly staff training sessions, and when an incident of any kind occurs, she's got the system's video footage to help make it a teachable moment. "It records everything going on in the pool and even on the pool deck," she said. "If a 3-year-old slips into the pool because the parent goes back into the locker room, we have footage of that. We can use it as training for our staff."

Munster added that these visual records can be useful for other reasons as well. "When an event happens, we have a record of it, which is very important. The first place people want to go is blaming the organization and blaming the staff. There are lots of wins [with the system]," he said. "It reinforces for lifeguards how important their job is, and it's a teaching aid we can use when we see things we want to improve upon."

And, although it's a challenge to hire enough lifeguards during the warm and sunny summers in Atlanta, McEwen said she's always pleased to see so many familiar faces at the start of the season. She believes the technology backup at the YMCA's pools is part of what keeps her guards coming back and cuts down on the number she must train from scratch each year.

It's pricey and it doesn't replace your current guarding staff, but Munster—and seemingly all the other users of such systems—wholeheartedly endorse them. "This is just another tool in the toolbox, another way to support our programs and keep our members safe," Munster said. "It's nothing more than that, but it makes an impression on people." It's definitely a point of interest on tours for prospective new members. "Parents feel safe," he said. "We don't overplay it, but we tell people about it."

Incorporating technology is not the only option out there for improving the safety of those enjoying your water. The U.S. Centers for Disease Control and Prevention (CDC) recently gathered an expert panel to discuss this very subject. "Our aim was to recognize a diversity of people interested in drowning prevention—parents, physicians, pool owners and operators, public health officers, builders, emergency responders," said Julie Gilchrist, M.D., of the U.S. Public Health Service. "If someone at the local or state level or in the industry wants to do something about drowning prevention, the idea was to create a tool kit of sorts that could jump-start their effort."

This project was spurred by the Virginia Graeme Baker Pool & Spa Safety Act, a law enacted in December 2007 that requires anti-entrapment drain covers and other safety features. It is named for the granddaughter of former Secretary of State James Baker III, who—despite being a strong swimmer—drowned in 2002 after she became trapped in a faulty hot tub drain.

The law provides money for states to enforce their laws related to this act, but so far no states have qualified for the funding. None have passed laws that are retroactive to cover existing pools, "so most pools are still a problem," Gilchrist said. By compiling this information, the experts hope to encourage states to get going, as well as assist a broad array of others interested in the subject.

The panel met in March 2011, and eventually their findings will be up on the CDC's Web site, although Gilchrist is not sure when. "I'd love to have it [available] for this season, but it's a long process," she said. However, it will certainly be worth the wait. The information will include a section about where to find relevant data, contact information for involved stakeholders, examples of successful policies and laws, and suggestions for public education. Rather than presenting new information, this is "more of a compilation of resources," Gilchrist explained. The site will also include case studies and descriptions and opportunities for networking and discussion about successes and challenges related to drowning prevention. Visit cdc.gov/injury and cdc.gov/healthywater for updates and to find this treasure trove when it's posted.


Ensuring Aquatic ADA Compliance

For more than 20 years now, the Americans with Disabilities Act has been paving the way for citizens with special needs to have equal access to public facilities, including recreation venues. On March 15, 2011, the latest revisions to accessible design regulations for public pools and spas became law. And compliance with these standards is required by March 15, 2012. This means even existing pools and spas must be modified to meet these standards.

These requirements include that pools longer than 300 linear feet have two accessible entrances. One may be a sloped entry, pool stairs, a transfer wall or system, or a pool lift, but the other must be a pool lift that can be independently operated by the person using it. (Not every type of lift will qualify, so be sure you're investing in one that actually satisfies the ADA's requirements.) Special-use pools (wave pools, leisure rivers, wading pools) and those smaller than 300 linear feet need only one accessible entrance.

Although public pools that can demonstrate hardship or that including such access would damage the historical integrity of their facility may be excused from doing so, the Department of Justice has expressed the opinion that given the array of options for meeting the standards and the relatively low cost of a pool lift, making the case for such exemption will be very difficult. A better option may be pursuing some of the tax incentives available to businesses seeking to comply with ADA regulations. Visit www.ada.gov/taxcred.htm to find this information.


Educating Users

Another powerful tool in the fight against drowning—as well as an excellent means of promoting overall safety—is making sure your facility has educated and informed users. This means clearly developing, posting and enforcing the safety standards and rules you deem appropriate for your pool (check with the American Red Cross and your state health department to be sure yours have everything covered), as well as encouraging those who come to swim, and their parents, to be knowledgeable about handling themselves in the water.

A number of organizations are making news where aquatic education is concerned, and their efforts can provide you with lots of ideas about getting your own facility involved.

The Make a Splash campaign, organized by the USA Swimming Foundation, is a child-focused water safety program that works with local swim lesson providers around the country to help every child learn to swim. Goals include educating parents about water safety and providing scholarships for children who might not otherwise have access to a learn-to-swim program.

The Colorado Springs Swim School is a local partner with Make a Splash, and owner Tina Dessart said they've had a great experience during their three years with the program. "Last year alone about 150 students got lessons this way," she said. "That's eight classes for each child."

The swim school was already offering a free "Learn to Swim" day each quarter to educate the community, which they continue to do. "That doesn't mean you learn to swim in one day, but it's an opportunity for people to come in and get to know the program and instructors, to see what we do," she said. "We provide information on water safety to parents and provide information on scholarships so [their kids] can turn around and participate in the lessons we have going on."

The Colorado Springs Swim School has also recently partnered with the largest local school district to create a program that will help those students learn to swim, and they also get the word out by including the Make a Splash logo on the Web site and in local advertising as well.

Another issue currently making waves in the world of swim lessons and aquatic user education is teaching the tiniest tots. Until recently, the American Academy of Pediatrics (AAP) was opposed to swim lessons for children under 3. "In the past, the AAP advised against swimming lessons for children ages 1 to 3 because there was little evidence that lessons prevented drowning or resulted in better swim skills, and there was a concern parents would become less vigilant about supervising a child who had learned some swimming skills," explains a May 17, 2010, statement from the organization.

However, recent studies have produced scientific evidence that shows young children who have had some formal swimming instruction are less likely to drown, so the AAP has revised its position to be more open to the possibility of teaching the smallest children.

"Children need to learn to swim," said Jeffrey Weiss, M.D., FAAP, lead author of the AAP's new policy statement. "But even advanced swimming skills cannot 'drown-proof' a child of any age. Parents must also closely supervise their children around water and know how to perform CPR. A four-sided fence around the pool is essential."

Bob Hubbard, owner of the Hubbard Family Swim School in Phoenix and a past president of the U.S. Swim School Association, agrees that educating parents is a key component of early swim lessons. "We've learned to take a more proactive role in educating parents," he said. "We have a safety week three times a year where we go over information with kids and parents. If you start early enough, the parent gets in the water and understands the child's capability. They see how quickly things can go wrong." This, he explained, makes them more vigilant about water safety.

Time spent in the water also makes kids safer around a pool, Hubbard said. "If a kid hasn't been exposed to water, if he doesn't understand or know the consequences…when he finally gets near it, he's attracted to it, so teaching appropriate behavior is good." But Hubbard is quick to add—just like the AAP—that no one can be taught to swim so well that they don't need supervision. The University of Arizona has one of the top 10 competitive swim teams in the country, yet two of Hubbard's staff members put themselves through college working as lifeguards for the team's practices. "If they have lifeguard on deck, you can never assume a child or adolescent is safe," he said.

To encourage early adoption of safe behaviors and familiarity with the water, Hubbard's swim school offers a free program for parents and babies called Baby Splash. The instruction is geared toward parents, who get into the water with their babies, and is designed to help them get comfortable with what's appropriate to do with their baby in the water, both in the pool and at home. "We believe in the safety component, but there's also a developmental component in play and stimulation that's huge," Hubbard said. He noted growing scientific evidence that shows water play to be beneficial to physical and neurological development in babies.

The AAP does not recommend formal instruction of any kind for babies less than 1 year old, but their new openness to lessons for children ages 1 to 4 is "a big step forward," said the NSPF's Lachocki. He pointed out that most drownings are in children between ages 1 to 4, so teaching kids to swim at age 5 may be too late.

"Anytime you can get a child even just acclimated to the water at a young age, the more confident and comfortable they'll be, so teaching them is easier," said the Colorado Springs Swim School's Dessart. "If a child is 4 or 5 and has no familiarity with the water, it can be a difficult transition for them."

Dessart noted that her school's early childhood lessons include parents in the water with their children from1 to 3 years of age, and much of the focus is actually on educating parents and showing them how to interact with their children in the water. It's not until age 3 that students work with a teacher in small groups.

Lachocki also pointed out that there are big-picture benefits to society—which is aging and increasingly overweight—when we find ways to engage children in physical exercise. "Having children learn to swim early or learn water safety and awareness opens the door to having more people engaged in a healthy activity they can do all their years," he said. And by offering this sort of education for parents and children, you're creating users who'll know how to enjoy the water safely at your facility for years to come.

Training Lifeguards

As mentioned in the previous section, no matter how skilled the swimmers in your water, having a great guarding staff is essential. Everyone knows lifeguards must be trained and certified, but what's the most effective way to do this? What qualities make the best lifeguard?

Beginning in 2005, representatives from the American Red Cross, the U.S. Lifesaving Association (USLA) and the YMCA of the USA gathered to form the U.S. Lifeguard Standards Coalition (USLSC). It seems they had identified a problem in the world of lifeguard training.

"As lifeguarding has evolved, lifeguard training methods and standards have been established primarily on the basis of experience and opinion," explains the final report the USLSC, released in February 2011. "This can be a result of trial and error (or success), or of the recommendations of people who are considered to be experts. Just as experience and expertise vary in different organizations, so do methods and standards."

Although lifeguard training seems like a highly organized endeavor, Lachocki of the NSPF, which provided funding for the project, pointed out that before this report, there was no way to know which training practices were based on scientific evidence. "So a lot of people are doing stuff out there with good intent and with commitment, but maybe it's not really the right thing."

The USLSC has done exhaustive research into a broad range of lifeguarding-related subject areas, including everything from physical requirements for success and how to manage cervical spine injuries to the effectiveness of online training. Although some of the evaluations have simply identified gaps where more study is needed, "half of the solution is defining the problem," said Lachocki. "This is really a seminal compilation of information that has to be considered relevant to the practices of any lifeguarding organization anywhere in the world."

Any group can now examine their own lifeguarding practices in light of the evidence available. For example, are you aware of the various external factors that may seriously impact your lifeguards' ability to be vigilant in doing their job? According to studies researched for the USLSC report, everything from encouragement from superiors to the belief that they're being monitored to how much sleep they got the night before to the temperature and noise level in the room to the amount of caffeine and sugar they've ingested can play a role in their effectiveness.

Although in many cases the report does not offer one definitive answer about what should or should not be done, "this allows us to start evolving what we're doing to make it better," Lachocki said. "Anyone making policy can use this."

Visit www.lifeguardstandards.org for more information about the project and to download a copy of the final report.


Fast Facts About Swimming and Drowning

Still not convinced that investing in drowning prevention efforts and providing early-childhood swim lessons makes sense? Perhaps these facts and figures, gathered by the USA Swimming Foundation for the 2011 National Drowning Prevention Symposium (held April 14 to 16, 2011, in Colorado Springs) and for their Make a Splash program, will provide some motivation:

  • Drowning is a leading cause of death for children ages 1 to 14.
  • Children between the ages of 1 and 2 represented about half of all submersion injuries from 2005 to 2009.
  • Most drownings and submersion injuries to children under age 5 during that period involved a swimming pool.
  • A recent study commissioned by USA Swimming and conducted by the University of Memphis found that nearly 70 percent of African-American children and 58 percent of Hispanic children have low or no swim ability, compared to 40 percent of Caucasians. According to the study, parental fear is a major contributor to a child's swimming ability.
  • Nine people drown each day in the United States, and in ethnically diverse communities, the youth drowning rate is more than double the national average.

Maintaining Healthy Water

Just as the USLSC has been scrutinizing training standards and practices for lifeguards, the CDC and public health and pool industry experts around the country (again with funding from the NSPF) have begun working together to tackle the challenge of identifying and maintaining appropriate health standards in aquatic facilities.

"In the United States, there is no federal regulatory authority for disinfected recreational venues; all pool codes are developed, reviewed and approved by state and/or local public health officials," the CDC reports on the project's Web site. "As a result, there are no uniform, national standards governing the design, construction, operation and maintenance of swimming pools and other treated recreational water venues." For example, regulations for dealing with recreational water illnesses (RWIs) vary significantly across the country.

To solve this problem and provide pool owners and managers across the country with a consolidated resource, this collection of professionals is working to create a Model Aquatic Health Code (MAHC), which will serve as a guide for those looking to make their own facilities and aquatic health policies the best and safest they can be. "The Model Aquatic Health Code (MAHC) is intended to transform the typical health department program into a data-driven, knowledge-based, risk reduction effort to prevent disease and injuries and promote healthy recreational water experiences," explains the CDC.

The project team has developed rigorous standards and procedures for creating each of the 13 modules that will make up the MAHC. Subject areas include everything from operator training to air quality to water disinfection to facility design, and although an assortment of experts produces the initial draft of each section, after review by the steering committee and editing for consistency, it is posted for public comment and review. After others from the field have had a chance to weigh in, the experts then review the comments and revise the section accordingly. You can examine each of the modules and get an update on their status by visiting www.cdc.gov/healthywater/swimming/pools/mahc/structure-content/.

This layered review process is intended to ensure thoroughness and scientific accuracy, and the MAHC committee hopes a first edition of the entire MAHC will be up for initial public review sometime in 2011. "Once all the MAHC modules are revised after their first 60-day review, the entire MAHC will be posted again for another 60-day public comment period to allow reviewers to review sections across modules and check the entire MAHC for completeness," explained Douglas C. Sackett, director of the MAHC.

Once the MAHC is complete, it will be posted to the CDC Web site for easy access. The committee's goal is that the MAHC be a "living document" that is updated regularly with the latest developments in the field and as new scientific data becomes available. Information about the project and modules up for review will also be available from the NSPF. Visit http://nspf.org/en/Resources/prevention.aspx to sign up to make sure you receive the latest news.

The committee is especially excited about the "Annex" portion of the MAHC, which will outline the scientific rationale behind the new model code's requirements and hopefully help operators understand why suggested changes are warranted. "One example of a proposed new change will be that all high-risk aquatic venues (such as wading pools, spas and therapy pools) will be required to use secondary disinfection by ozone or ultraviolet radiation treatment," says Sackett. "Other proposed changes include requiring trained operators at aquatic facilities, requiring chemical controllers, chemical storage room guidelines, improved requirements for air ventilation, and the development of best practices for regulatory programs," he reports.

That sounds like a lot, but it's important to remember this is a model that state and local agencies may adopt in part, not at all, or not all at once. "The model is a guidance document, based soundly on current science," said Tracynda Davis, MPH, director of Environmental Health Programs for the NSPF and member of the MAHC committee. "We hope local and state jurisdictions adopt these guidelines over time and incorporate them in part or entirely in their pool regulations."

Sackett added that there will be an array of benefits if the MAHC is adopted across the country. "It will bring uniformity by providing the most current, science-based guidelines for design and operation of swimming pools and improve public health," he said. "In addition, aquatics industry professionals who work in multiple jurisdictions that adopt the MAHC will be able to follow a single code, not different codes in different jurisdictions." And that's something that makes everyone's life easier, as well as healthier.

So, although maintaining a safe, healthy, and fun aquatic recreation area is by no means a simple task, there are ever-increasing (and ever-better-organized) resources available to assist you in all aspects of this endeavor. This summer, have fun and use these tools to keep your swimmers safe!



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